Contemporaneous Evaluation of Kawasaki Disease and Multi-system Inflammatory Syndrome in Children in Northern Virginia

Background. Multi-system inflammatory syndrome in children (MIS-C) can present like Kawasaki disease (KD). After Centers for Disease Control and Prevention guidance was issued in May 2020, we implemented local management strategies emphasizing limited laboratory work up of non-toxic children with suspected MIS-C or KD. We then re-evaluated our management recommendations to ensure appropriate resource utilization for children with MIS-C and KD. Methods. We identified MIS-C and KD cases via convenience sampling of Pediatric Infectious Diseases records at Inova Fairfax Medical Center from May 1, 2020 to February 28, 2021. Manual chart review extracted clinical points of interest and descriptive statistics compared cohorts. Oral changes included edema, erythema, cracking, or strawberry tongue. Abdominal symptoms included pain, emesis, and diarrhea. Respiratory symptoms included shortness of breath, tachypnea, cough, and need for mechanical ventilation. Musculoskeletal symptoms included pain and edema. Neurological symptoms included headache, dizziness, altered mental status, and irritability. Results. We identified 8 KD cases and 29 concurrent MIS-C cases. MIS-C cases tended to be older and have presenting abdominal symptoms (median age 8 years old versus 2 years old, p < 0.01) and hypotension (20 versus 0, p < 0.01), otherwise there was no difference in the frequency of oral changes, rash, conjunctivitis, musculoskeletal symptoms, or neurological symptoms. 7 KD cases and 8 MIS-C cases did not require intensive care. Patients with MIS-C who did not need intensive care still had a lower initial absolute lymphocyte count (ALC) (median 1275/μL, p < 0.01), lower initial platelet count (median 217/μL, p = 0.05), and higher initial C-reactive protein (CRP) (median 18.3 mg/dL, p = 0.06) compared to KD cases;other results were not different between the two cohorts. Conclusion. We observed differences in the initial ALC, platelet count, and CRP between KD and MIS-C cases not requiring intensive care, whereas other labs such as ferritin, troponin, B-natriuretic peptide, and initial echocardiograms did not significantly differ between the two cohorts. Thus, our diagnostic management recommending limited laboratory evaluation for non-toxic patients with suspected KD or MIS-C is reasonable.

Contemporaneous evaluation of Kawasaki disease and multisystem inflammatory syndrome in children cases in Northern Virginia

Background: Multisystem inflammatory syndrome in children (MIS-C) has a temporal association with SARS-coronavirus 2 (SARS-CoV-2) infection and can present similarly to Kawasaki disease (KD). After the Centers for Disease Control and Prevention issued a MIS-C case definition in May 2020, we implemented local diagnostic and management strategies to standardize the care for patients with MIS-C encouraging limited laboratory evaluation of non-toxic patients presenting with a febrile illness. We then sought to re-evaluate our diagnostic and management recommendations to ensure appropriate resource utilization for children with MIS-C and KD.

Increasing food insecurity screening at a pediatric community clinic during the

Introduction: Food Insecurity is a household's lack of access to adequate food necessary for a healthy life. In 2018, 11.1% of the United States households were considered food insecure which translates to about 14.3 million people. Although the US Department of Agriculture and its agency Food Nutrition Services have been monitoring the prevalence of food insecurity for over two decades, this social issue has gained its most attention as a result of the CDC's recommendation of primary prevention strategies in curbing Adverse Childhood Experiences (ACEs). It is now a fundamental part of the pediatrician's role to screen families and take measures to minimize food insecurity in order to prevent children from developing the long term effects of ACEs. During COVID-19 pandemic, the actions taken to prevent spread, such as school closures, and the rise in unemployment will increase the percentage of families touched by food insecurity. For example, about 52,600 students who depend on free or reduced school meals have not received this aid because of school closures. Objective: This quality improvement initiative aims to increase the percentage of patients screened for food insecurity by 50% in 6 months. This project takes place in a teaching safety-net pediatric clinic, which acts as a medical home for children of low-income families on Medicaide or without insurance, including undocumented individuals who do not qualify for federal aid. Methods: A screening tool was developed. It is made up of a four- item questionnaire including the Hunger Vital Sign promoted by the American Academy of Pediatrics (AAP) Policy, Promoting Food Security for All Children, an assessment of any direct effects of the COVID -19 pandemic, and a question that identifies families who need immediate assistance. A handout of local food resources was created and can be printed for clinic visits and also texted or emailed for virtual visits. All patients receive this list, and patients with emergent needs are referred to receive same day aid. An educational module was created for resident physicians on food insecurity, its impacts and local rates, as well as recommendations from the AAP on screening. The primary outcomes are the percent of patients who utilize local food resources and the change in food insecurity by telephone follow-up. The process measure is the percent of patients screened for food insecurity. Results: Thus far, interventions have increased the percentage of families screened from 1.5 to 5. By the time of the AAP Conference, outcome measure results will also be available. Discussion: Ultimately, we aim to increase the percentage of families with food insecurity who are able to access food through local resources and upon follow-up have a lower food insecurity risk score.